Can We Optimize Antibiotic Use in Norwegian Neonates? A Prospective Comparison Between a University Hospital and a District Hospital

Abstract

Background: Worldwide, a large proportion of neonates are prescribed antibiotics without having infections leading to increased antimicrobial resistance, disturbance of the evolving microbiota, and increasing the risk of various chronical diseases. Comparing practice between different hospitals/settings is important in order to optimize antibiotic stewardship.Aim: To investigate and compare the potential for improved antibiotic stewardship in neonates in two Norwegian hospitals with different academic culture, with emphasis on antibiotic exposure in unconfirmed infections, treatment length/doses, CRP values and the use of broad-spectrum antibiotics (BSA). All types of infections were investigated, but the main focus was on early-onset sepsis (EOS).Methods: We conducted a prospective observational cohort study of antibiotic use in a Norwegian university hospital (UH) and a district hospital (DH), 2017. Unconfirmed infections were defined as culture negative infections that neither fulfilled the criteria for clinical infection (clinical symptoms, maximum CRP >30 mg/L, and treatment for at least 5 days).Results: Ninety-five neonates at the DH and 89 neonates at the UH treated with systemic antibiotics were included in the study. In total, 685 prescriptions (daily doses) of antibiotics were given at the DH and 903 at the UH. Among term and premature infants (≥ 28 weeks), 82% (75% at the UH and 86% at the DH, p = 0.172) of the treatments for suspected EOS were for unconfirmed infections, and average treatment length in unconfirmed infections was 3.1 days (both hospitals). Median dose for aminoglycoside was higher for term infants at the UH (5.96, 95% CI 5.02–6.89) compared to the DH (4.98, 95% CI 4.82–5.14; p < 0.001). At the UH, all prescriptions with aminoglycosides were gentamicin, while tobramycin accounted for 93% of all prescriptions with aminoglycosides at the DH.Conclusion: There is a potential for reduction in both antibiotic exposure and treatment length in these two neonatal units, and a systematic risk/observational algorithm of sepsis should be considered in both hospitals. We revealed no major differences between the UH and DH, but doses and choice of aminoglycosides varied significantly.

Effects of early-life antibiotics on the developing infant gut microbiome and resistome: a randomized trial

“…For this reason, more emphasis on improving the diagnostic accuracy of EONS is crucial, as the principle of when in doubt, there's no harm in treating appears far from true. Reducing the number of neonates in whom we initiate broadspectrum antibiotic treatment is feasible, given the fact that prescription rates vary widely even between European countries with similar infection statistics 37,38 . This strongly suggests that guidelines underpinning these national differences should be compared to identify factors that could lead to more reserved prescription practices.…”

Effect of antibiotics in the first week of life on faecal microbiota development

“…The long-term microbiota effect of ABs and its associated negative health outcomes reinforce the need for implementing AB stewardship programs53–55 to avoid AB overuse 21 56 57. The microbiota perturbations were only significant after 5–7 days compared with 2–3 days AB which could explain previous findings from the INCA cohort: namely higher incidence of infantile colic, wheezing and food allergies in infants exposed for 5–7 days, but not for 2–3 days 10 58.…”